.The Adult and Young Adult DBT Program consists of three components: individual therapy, skills group and between-session coaching when crises arise.
DBT Skills Groups
Adults of all ages will progress more quickly if they attend a skills group in addition to individual therapy, especially in Stage 1. St Louis DBT offers skills groups for young adults ages 17-26 and adults age 26 and over. The adult program also offers a DBT Substance Use Disorders Skills Group for adults 18 years and older.
Skills groups provide participants with the opportunity to learn and practice skills in a classroom setting with support and encouragement from each other. Learn more about adult and young adult skills groups.
In adult and young adult therapy, you will learn skills, apply them to current issues in your life, track your progress and enhance your motivation.
Assessment & Treatment Planning. In your first sessions, you and your therapist will assess what stage you are in and develop treatment goals to meet your needs. STLDBT uses two questionnaires to assess where you are as you enter treatment: Difficulties in Emotion Regulation Scale (DERS) and the DBT Ways of Coping Checklist (WCCL).
Based on these assessments, your history and your goals for therapy, you and your therapist will develop a treatment plan. This is intended to be a flexible document that guides your treatment.
While each session will differ, there are some elements that will be addressed in each session.
Review Diary Cards. Each week, you will complete a diary card, monitoring your emotions, urges and actions and identifying the DBT skills you used to address them. Your diary “card” may be paper cards, an app on your phone, or an electronic/computerized version of the card.
Behavior Chain Analysis. Focusing on current problems, you will learn to effectively and non-judgmentally analyze your problem behaviors and come up with practical solutions. You will practice analyzing your problem behaviors at each session, focusing on here-and-now problems.
Skills Application. Each week, you will talk about and practice skills learned in DBT Skills Group.
Monitoring Progress. Periodically, you and your therapist will establish behavioral targets. Each session, you will monitor urges and responses that lead you closer to or further from achieving your behavioral targets Targets are prioritized from self-harming behaviors getting the highest priority to therapy-interfering behaviors to quality of life interfering behaviors.
Homework. Making progress requires practicing skills between sessions. Each week, you and your therapist will devise a plan for homework that is both effective and doable given demands on your time. You will often be able to do your homework in the course of your day, being mindfully aware of opportunities to apply skills at home, school, work and in social situations.
Ongoing Assessment: Periodically, your therapist will ask you to complete the WCCL and DERS assessments to measure your progress
Therapists are available seven days a week for between-session crisis coaching by telephone, email and/or text. These calls are no more than 10-15 minutes. Typically, your therapist will ask what skills you have tried and suggest additional skills.
Starting Where You Are
We start therapy where you are. Clients come to us in different stages. The four stages of adult and young adult treatment are:
Stage 1: Your life is in chaos:
In this first stage, your life feels out of control and you are miserable. You might even describe it as a “living hell.” In this stage, treatment focuses on getting control of your behaviors.
Adults who enter treatment at this stage are actively struggling with life threatening behaviors, including suicidal ideation or attempts, excessive drinking or drug use, disordered eating, cutting and other self-harming behaviors,. At this stage, you may know you have to do something but you’re not fully committed to therapy yet. The challenges you face may make it difficult to hold down a job, get along with others, go to school or get things done.
At this stage, the program helps you gain behavioral control because living an out-of-control life is miserable and progress cannot be made on underlying emotional issues until you have the skills to manage emotion without engaging in dangerous behaviors
Stage 2: You live in quiet desperation from past trauma
In this second stage, you may have experienced either “Big T” trauma (e.g., rape, domestic violence, childhood abuse, combat, assault, gun violence) or “Little t” trauma — a lifetime of invalidation — or both. The past haunts your present. You are likely living a life of quiet desperation.
You will explore past trauma, and identify maladaptive thoughts, beliefs and behaviors. You do this by remembering and accepting facts of earlier traumatic events, reducing self-blame as well as acknowledging and letting go guilt and shame. You will only start trauma work when self-harming behaviors are under control.
Stage 3: Who am I?
At this third stage of treatment, happiness seems just out of reach. You ask, “Who am I if my life is not in chaos and I’m not fighting myself?
At this stage, the Adult and Young Adult Program focuses on solving problems of everyday living to find peace and happiness in ordinary life. This means accepting that both happiness and unhappiness are part of ordinary life. In this stage, the challenge is to take responsibility for your life, define life goals, build self-respect, and learn to trust yourself.
Stage 4: You crave a sense of higher purpose
In this fourth stage, you want something more than ordinary happiness. You want to feel joy and freedom.
This stage focuses on finding and experiencing deeper meaning. It asks the questions, “What is my purpose in life? Why was I put on this Earth?” The goal is to learn to live a life of freedom and joy, not by transcending the ordinary but by discovering the extraordinary in the ordinary and loving what is.